Pre-pregnancy care--a logical extension of prenatal care.
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Abnormalities, Drug-Induced↗
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The relationship between women's satisfaction with prenatal care service and the characteristics of the pregnant women and the service.
OBJECTIVE: The purpose of this descriptive correlational study was to investigate the relationship between women's satisfaction with prenatal care services and the demographic characteristics of the women and the service's features. METHODS: The population studied consisted of Turkish women living in Erzurum, Turkey, who had delivered their infants and were still hospitalized. The women had received prenatal care, had no complications during pregnancy, carried their pregnancies to term, and were considered to have had normal deliveries. The sample size was determined as 367 women, and 350 women responded to the questionnaire. Question items consisted of women's satisfaction with prenatal care services, the demographics characteristics of the pregnant women, and the characteristics of prenatal care. The questionnaire was given to the women in the birthing house. The researchers collected data using an interview method between 1 January and 30 April, 2002. RESULTS: In terms of the mean item score and total scale, the women were 'somewhat satisfied' with the prenatal care service. The women were more satisfied with health-care information and the 'cost of the service' dimension of the scale. There was an association between women's satisfaction with prenatal care services and the characteristics of both prenatal care and those of the pregnant women. CONCLUSION: The sample of women in this study reflects only the study population in this area of Turkey. The findings of the study should be limited to this population. The scale would be useful for further studies investigating how prenatal care providers can better identify women's satisfaction with prenatal care service. A satisfaction measurement scale of prenatal care services would be helpful as an interview form that could identify the satisfaction scale and rate the scale's importance in the health-care provider's office, hospital, during a home visitation, or a primary health-care center, private clinic or maternity and child health center.
Adolescent↗
Opportunities for intervention: discussing physical abuse during prenatal care visits.
BACKGROUND: The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists recommend that screening for physical abuse during prenatal care visits becomes routine. Although prenatal care visits offer a unique intervention opportunity, screening is not yet standard practice. DATA AND METHODS: We used data from the 1996 and 1997 Pregnancy Risk Assessment Monitoring System (PRAMS) to assess the prevalence of and the factors associated with health care providers' discussion of physical abuse with pregnant women in 14 states. PRAMS is a state-specific, population-based surveillance system that collects information from women on maternal behaviors before and during pregnancy, and at 2 to 6 months postpartum. RESULTS: Between 22% and 39% of the women surveyed reported that health care providers talked with them about physical abuse during prenatal care visits. Health care providers were more likely to discuss physical abuse with women who were black, Hispanic, young (aged <20 and 20 to 29), had a high school education or less, or paid for prenatal care with Medicaid. CONCLUSIONS: Our results indicate that most pregnant women do not report that their prenatal care providers discussed physical abuse with them. Logistic regression analyses identified consistent associations across the 14 states between discussion of abuse and demographic and pregnancy-related factors. A better understanding of the factors associated with whether a health care provider discusses physical abuse with a pregnant woman could increase intervention opportunities.
Adult↗
Effect of prenatal care on infant mortality rates according to birth-death certificate files.
Infant mortality has decreased nationwide; however, our national rates still log behind those of other industrialized countries, especially the rates for minority groups. This study evaluates the effect of prenatal care and risk factors on infant mortality rates in Chicago. Using linked infant birth and death certificates of Chicago residents for 1989-1995, a total of 5838 deaths occurring during the first year of life were identified. Birth certificate variables, especially prenatal care, were reviewed. Variables were compared by stratified analysis. Pearson chi 2 analysis and odd ratios (ORs) were computed. Infant mortality rate (IMR) in Chicago decreased from 17 in 1989 to 12.6 in 1995 (P < .0001). Some factors increased IMR several fold: prematurity (OR 17.43), no prenatal care (OR 4.07), inadequate weight gain (OR 2.95), African-American ethnicity (OR 2.55), and inadequate prenatal care (OR 2.03). Compared with no care, prenatal care was associated with lower IMR; however, early care was associated with higher IMR and ORs than later care. These results demonstrate prenatal care is associated with lower IMR; however, compared with late prenatal care, early care does not improve IMR. Further studies should evaluate whether improving the quality of care improves IMRs.
Adolescent↗
Barriers to prenatal care for low-income women.
Inadequate prenatal care is associated with poor birth outcomes. Recognizing barriers to care is necessary to improve results. Postpartum in-hospital interviews were conducted with women admitted through emergency departments with no physician of record (n = 69) in 8 Sacramento hospitals during April and May 1991. A focus group of local obstetrician-gynecologists was used to determine physicians' attitudes about caring for low-income women. We undertook the study in response to an increased number of "no doc" births. The inability to find a physician willing to accept them was reported by the women as the single largest barrier to obtaining care, cited by 64% of women overall and 96% of those who tried but were unable to obtain care. Transportation difficulties were a problem regardless of women's success in obtaining care and were ranked as the top barrier by women who never tried to obtain care. Physicians cited administrative difficulties and reimbursement levels of Medi-Cal plus extra care requirements and resource dependency of low-income patients as barriers to caring for this population. The value ascribed to prenatal care by women and physicians' perceptions of women's attitudes about care contrasted sharply. The link between poor women and physicians providing obstetric services can be fragile. The difficulty finding physicians willing to take them indicates that these women need special support services to ensure adequate care during pregnancy.
Adolescent↗
The effects of prenatal care utilization and maternal risk factors on pregnancy outcome between Mexican Americans and non-Hispanic whites.
This study evaluates the effects of prenatal care classification and levels of maternal risk status on pregnancy outcomes in Mexican Americans and non-Hispanic whites in Arizona. All live birth certificates from 1986 and 1987 were reviewed yielding a total population of 101,206 (26,827 Mexican Americans). The adequacy of prenatal care was evaluated based on an index that includes six prenatal care groups. Two levels of maternal risk status (low and high) were defined based on a series of maternal risk factors. Overall, Mexican Americans had a greater proportion of maternal risk factors and a greater proportion of mothers with inadequate or no prenatal care compared with non-Hispanic whites. Prematurity and macrosomia were more prevalent than low birthweight in Mexican Americans. Low-risk status and adequate prenatal care regardless of ethnicity were found to be associated with a lower prevalence of low birthweight and preterm delivery. Whites, however, had a greater variation in the prevalence of low birthweight associated with changes in prenatal care utilization and maternal risk status compared with Mexican Americans. Finally, logistic regression analysis showed an independent effect of prenatal care, maternal risk status, maternal age, and maternal birthplace in predicting the overall low birthweight rate in Mexican Americans. The implications of these results are discussed relative to the usefulness of prenatal care as a health-care intervention in Mexican Americans.
Female↗
[Comparison of 2 indexes of prenatal care and risk of preterm delivery].
OBJECTIVES: A new index the adequacy of prenatal care utilization (APNCU) index, has been proposed to provide a more accurate and comprehensive measure of antenatal care use than the widely used Kessner index. To better understand the value of the two above mentioned indexes as predictors of preterm delivery, we examined their ability to predict women who will or will not deliver before 37 weeks of gestation. METHODS: A case-control study was performed, including 207 cases and 381 controls. Prenatal care was assessed on the basis of the two above mentioned indexes, both taking into account the number of prenatal care visits, the date of the first visit and gestational age. Multiple-factor adjusted odds ratios and their 95% confidence intervals were estimated using logistic regression methods. RESULTS: The Kessner index showed a lineal trend with both crude and adjusted for (the APNCU index) estimates of preterm delivery risk. The APNCU index did not show any linear trend with adjusted for (the Kessner index) estimates of preterm delivery risk. To assess whether the Kessner index added explanatory information to the APNCU index (or vice versa), the APNCU index was regressed on the Kessner index (and viceversa), and a set of residuals was computed for both indexes. In logistic regression analyses, the residuals of Kessner added meaningful information to the APNCU index, whereas the residuals of the APNCU index did not add any relevant information to the Kessner index. There results remained unchanged after controlling for several confounders. CONCLUSIONS: A variation in the definition of adequate prenatal care use changes the association between prenatal care and preterm delivery. The Kessner index showed a better ability for discriminating and predicting the risk of preterm delivery.
Adult↗
Differences in neonatal mortality by race, income, and prenatal care.
To determine the extent to which the social and physical environment affects the association between prenatal care and black pregnancy outcome in Chicago, we performed a stratified analysis of 1982-1983 Illinois vital records and 1980 United States census income data. Median family income of the mother's census tract was used as the ecologic variable. In very-low-income census tracts (less than $10,000 per year), 40% of blacks and 47% of whites received adequate prenatal care. There was no racial disparity in the percentage of low-birth-weight infants attributed to inadequate prenatal care among poor mothers. For mothers who resided in moderate-income areas ($20,001 to $30,000 per year), 50% of blacks and 67% of whites received adequate prenatal care. Although adequate (compared to inadequate) prenatal care was associated with improved birthweight distribution independent of community income, only in moderate-income areas was it related to black neonatal survival. For term black infants who received adequate prenatal care, residence in impoverished areas was associated with a nearly fourfold greater neonatal mortality rate (deaths per 1000 live births): 5/1000 vs 1/1000; RR = 3.8 (1.3-11.0). We conclude that place of residence is an important risk factor for black neonatal mortality.
Black or African American↗
Factors affecting number of prenatal care visits during second pregnancy among adolescents having rapid repeat births.
PURPOSE: To examine factors associated with the number of prenatal care visits during second pregnancy for adolescents having a short interval between pregnancies. METHODS: The sample includes all adolescents aged 13 to 17 years whose first pregnancy resulted in a birth at a regional medical center in southeastern North Carolina from January 1983 to December 1989 and who had a repeat pregnancy within 24 months which resulted in a birth. We abstracted data from medical records and birth certificates. We fit a negative binomial regression model to determine the effects of various factors on the number of prenatal care visits during second pregnancy. RESULTS: The number of prenatal care visits during the first pregnancy, poor first birth outcome, interval between first and second pregnancy, and care provided by health department staff during first pregnancy were all positively associated with number of prenatal care visits during second pregnancy when controlling for gestation age of second birth. Other independent variables in the model included maternal age, education, black race, and being unmarried at the time of second birth. CONCLUSIONS: Because prenatal care is important for healthy mothers and babies, adolescents should be encouraged to seek prenatal care early in the first pregnancy. This could be an important time to implement interventions aimed at increasing prenatal care utilization in this and subsequent pregnancies.
Adolescent↗
Prenatal care in the United States, 1980-94.
OBJECTIVES: This report examines trends in timing of prenatal care in the United States from 1980 to 1994. Demographic characteristics examined include age, race, Hispanic origin, marital status, place of birth of mother, educational attainment of mother, and live-birth order. Social characteristics discussed include barriers to care and pregnancy wantedness. METHODS: The source of data for trends and demographic analysis is the certificate of live birth filed for each child born in the United States. Data for social characteristics are from the 1988 National Maternal and Infant Health Survey (NMIHS). Data from the NMIHS are based on 9,953 responses. RESULTS: Very few groups of women have yet to achieve the goal of 90 percent initiating prenatal care in the first trimester as set by Healthy People 2000. In 1994, 80 percent of all mothers initiated care in the first trimester. Cuban mothers were the only mothers to reach the objective of 90 percent with Japanese mothers close behind at 89 percent. Mothers with the lowest percent initiating early prenatal care were non-Hispanic black (68 percent), Puerto Rican (67 percent), and American Indian mother (65 percent). Mothers who have problems getting prenatal care due to financial, scheduling, transportation, or other problems have lower rates of initiating early care. Mothers who wanted to be pregnant when they did were more inclined to initiate early care than mothers who did not want to become pregnant or whose pregnancies were mistimed. CONCLUSIONS: Prenatal care use in the United States did not improve in the 1980's but has been improving since 1990. Variations in use by demographic characteristics persist. There are wide gaps between mothers with easier access to prenatal care and those who encounter barriers to care. Mothers who want to become pregnant also tend to seek help in understanding their pregnancy and its risks earlier than those who did not intend to get pregnant or cared to become pregnant at another time.
Adolescent↗
[Adequacy of prenatal care and birthweight: a systematic review].
This was a systematic literature review on publications in which prenatal care was investigated as a predictive factor for birthweight. The MEDLINE, Cochrane Library, and SciELO databases were searched using a combination of the following uniterms: "prenatal care", "antenatal care", "quality", "adequacy", "birthweight", and "low birthweight". Twenty-five studies were found: seventeen had a cross-sectional design, in addition to four cohort studies, three case-control studies, and one randomized trial. The adequacy indicators related to utilization (quantitative measures) and content of prenatal care (process or qualitative indicators). Most authors employed quantitative indicators, mainly the Kessner Index and the Adequacy of Prenatal Care Utilization Index. Qualitative criteria were used in only two studies. Most of the cross-sectional studies found a protective effect of prenatal care against low birthweight, whereas results of studies with other designs were conflicting. This review's findings highlight that the impact of prenatal care on birthweight is not unequivocal, mainly due to the effect of self-selection bias. Randomized trials are needed to elucidate such a relationship.
Birth Weight↗
Prenatal care and prematurity: is there an association in uncomplicated pregnancies?
A retrospective investigation examined patterns of use of prenatal care and pregnancy outcomes (low birthweight and preterm births) in 6176 pregnancies without antepartum medical complications. Prenatal care use patterns differed significantly by mother's age, marital status, race, education, method of payment, and gravidity. By controlling for these differences through a logistic regression procedure, results showed that prenatal care was associated with significant reductions in the number of infants who were delivered preterm or had low birthweight. Fewer very low-birthweight (less than 1500 g) infants were among the preterm infants delivered to mothers with prenatal care compared with women who received no prenatal care. These data suggest that significant improvements in pregnancy outcomes are seen among women who use prenatal care, and these benefits occur in the absence of antepartum complications.
Adolescent↗
Does inadequate prenatal care contribute to growth retardation among second-born African-American babies?
The authors evaluated the relation between adequacy of prenatal care and risk of delivery of full term small-for-gestational-age (SGA) infants. Data were derived from maternally linked birth certificates for 6,325 African-American women whose first two pregnancies ended in singleton, full term live births in Georgia from 1989 through 1992. The authors used stratified analysis to assess the effect of prenatal care on the risk of having an SGA baby in the second pregnancy among women with and without an SGA baby in their first pregnancy. The group of women with a history of SGA birth may be more likely to include persons for whom SGA delivery is related to factors, such as genetics, that are not amenable to intervention by prenatal care. Inadequate prenatal care was not associated with the risk of SGA delivery among women who had previously delivered an SGA baby. In unadjusted analyses, inadequate prenatal care was associated with an increased risk of delivering a full term SGA baby in the second pregnancy among women whose first baby was not SGA (risk ratio = 1.28; 95% confidence interval: 1.05, 1.55). The association did not persist when data were adjusted for confounding variables (odds ratio = 1.11; 95% confidence interval: 0.89, 1.38). Regardless of outcome in the first pregnancy, adequate prenatal care did not reduce the risk of full term SGA birth among second pregnancies in this population.
Adolescent↗
A study to determine the incidence and prevalence of newly discovered human immunodeficiency virus infection during the prenatal care period.
OBJECTIVES: This study asked the following questions: 1) Does HIV testing in pregnancy identify women who previously were not known to be HIV positive? 2) When in pregnancy are women identified as HIV infected? 3) Does HIV seroconversion occur during the prenatal care period? METHODS: Medical records of 97 women from two primarily indigent care hospitals in Houston, TX who were found to be HIV positive at delivery were reviewed to determine if they had tested positive during the prenatal care period. Demographics and time of gestation of the prenatal testing also were recorded. The outcome measures were: 1) number of women found positive during prenatal care; 2) week of gestation at discovery of HIV positivity; and 3) number of women seroconverting between the initiation of prenatal care and delivery. RESULTS: Thirty women were known to be HIV positive prior to pregnancy. Fifty-six women were found to be positive during prenatal care and the seropositivity of 44 was discovered before the 34th week of pregnancy. Ten women were found to be positive at their first prenatal visit, which occurred after the 34th week. Date of testing was unknown for two women. Eleven women who received no prenatal care were found to be HIV positive at delivery. There were no seroconversions while women were under prenatal care. CONCLUSIONS: HIV testing at delivery did not find any HIV-positive women who had tested negative during prenatal care. Testing is very important for women who do not receive prenatal care. Making certain that high-risk women get into prenatal care also is very important.
Adolescent↗
Prenatal care use in nonmetropolitan and metropolitan America: racial/ethnic differences.
Pregnant women in nonmetropolitan communities are believed to use prenatal care services at lower rates than are metropolitan residents due to higher levels of poverty, lower levels of insurance coverage, and declining numbers of local hospitals and physicians. Yet scarce data exist on actual patterns of prenatal care use in nonmetropolitan areas. This study provides national estimates of prenatal care use among African American, White, and Hispanic women who delivered in 1988 in non-metropolitan and metropolitan areas of the United States. This study finds that nonmetropolitan residents are no more likely than metropolitan residents to go without care, to enter care late, or to make fewer visits. Nonmetropolitan residents are more likely to receive "inadequate" prenatal care as measured by the Kotelchuck Adequacy of Prenatal Care Utilization Index, with Hispanic residents having the highest rates of inadequate care. These findings are consistent with recent state-level reports, and they suggest the need to target prenatal care policies for populations in greatest need.
Ethnicity↗
Health promotion and psychosocial services and women's assessments of interpersonal prenatal care in Medicaid managed care.
OBJECTIVES: If prenatal health promotion and psychosocial support services are to remain accessible to Medicaid eligible women, evidence is needed as to whether the services improve care and benefit women in ways that matter to health plans. The aims of this study are to determine whether prenatal health promotion and psychosocial services are associated with better interpersonal care and greater satisfaction with care; and whether the effects on interpersonal care help explain satisfaction with care. RESEARCH DESIGN: A telephone survey of 363 African American, Latina (US and nonUS-born) and White women receiving prenatal care in four Medicaid public health plans in California in 2001. Multivariate regression analyses were done with adjustments for potentially confounding variables. MEASURES: Independent variables included dichotomous variables for health promotion advice (five separate areas) and composite scales for psychosocial assessment (six areas combined). Dependent variables included satisfaction with care, and indices for interpersonal care (communication, decision-making, and interpersonal style). RESULTS: Women who report receiving health promotion or psychosocial services also report receiving better interpersonal care and rate their satisfaction with care higher. Receiving either type of support service is associated with higher quality communication, decision-making and interpersonal style. The effects of the support services on satisfaction are, in turn, explained by the effects on interpersonal care. CONCLUSIONS: Prenatal health promotion and psychosocial services have associated benefits to enrollees that should matter to Medicaid health plans and their providers.
Adolescent↗
Selection of a physician for prenatal care.
The selection of a physician for prenatal care was studied as a model of the generic process of choosing a physician. The results suggest that factors important in this process are similar to those relating to satisfaction with care: physician competence, cost and convenience, and personal qualities. Women selecting obstetricians for prenatal care placed a higher emphasis on physician competence, whereas those selecting family physicians placed a greater emphasis on cost and convenience.
Adult↗
Teenagers' perceptions of barriers to prenatal care.
A structured interview conducted during the postpartum hospitalization of 184 patients aged 17 years or younger was used to study teenagers' perceptions of barriers to prenatal care. The interview consisted of more than 100 questions on demographic characteristics, family and social support, desire for the pregnancy, perceptions of the importance of prenatal care, practical obstacles to access to health care (such as lack of transportation, day care, etc), financial problems related to care, problems finding time to obtain health care, knowledge of available prenatal care resources, and perceptions of ease or difficulty in the use of existing clinics. Multiple regression analysis using the Kessner index as the criterion variable showed that major factors related to the adequacy of prenatal care received by these teenagers were perceptions of cost barriers, the gestational age at which the teenager discovered she was pregnant, school enrollment status (those in school received poorer care than those who had dropped out), and the degree of social support experienced by the teenager. These findings suggest that specific changes in the health care system are needed to make prenatal care more accessible for pregnant teenagers. These changes would include enhancing community awareness that Medicaid pays for prenatal care, establishing links between prenatal clinics and school health systems, and scheduling prenatal clinics at times more convenient for teenagers.
Adolescent↗